肥胖产妇分娩镇痛优化策略:硬脊膜穿破硬膜外阻滞联合程控硬膜外间歇脉冲注入  

Optimization strategy of labor analgesia in obese parturients: dural puncture epidural combined with programmed intermittent epidural bolus

作　　者：苏春侠 李梦倩[1] 茅晓玉 吴树彪[1] 李治松 Su Chunxia;Li Mengqian;Mao Xiaoyu;Wu Shubiao;Li Zhisong(Department of Anesthesiology,The Second Affiliated Hospital of Zhengzhou University,Zhengzhou 450014,China)

机构地区：[1]郑州大学第二附属医院麻醉科,郑州450014

出　　处：《中华麻醉学杂志》2023年第10期1201-1204,共4页Chinese Journal of Anesthesiology

摘　　要：目的评价肥胖产妇分娩镇痛优化策略:硬脊膜穿破硬膜外阻滞(DPE)联合程控硬膜外间歇脉冲注入(PIEB)。方法选取拟行分娩镇痛初次妊娠、单胎、头位、足月妊娠肥胖初产妇80例,年龄20~40岁,ASA分级Ⅰ或Ⅱ级,BMI 30~40 kg/m2,孕37~42周,宫口扩张2~5 cm,VAS评分≥50 mm。采用随机数字表法分为2组(n=40):DPE+PIEB组(DPEP组)和DPE+持续硬膜外输注组(DPEC组)。DPEP组参数设置:首剂量8 ml,背景剂量2 ml/12 min,PCEA剂量5 ml,间隔时间20 min。DPEC组参数设置:首剂量8 ml,背景剂量10 ml/h,PCEA剂量5 ml,间隔时间20 min。镇痛泵中均使用0.1%罗哌卡因+0.3μg/ml舒芬太尼,记录达到充分镇痛的时间、单位时间罗哌卡因用量、胸段感觉阻滞程度、改良Bromage评分、PCEA有效按压次数、补救镇痛次数、Apgar评分、分娩方式、不良反应发生情况及产妇对分娩镇痛满意度。结果与DPEC组比较,DPEP组达到充分镇痛的时间缩短,单位时间罗哌卡因用量降低,补救镇痛次数和PCEA有效按压次数减少(P<0.05)。2组胸段感觉阻滞平面、改良Bromage评分、Apgar评分、分娩方式、不良反应发生率及产妇对分娩镇痛满意度比较差异无统计学意义(P>0.05)。结论DPE联合PIEB用于肥胖产妇分娩镇痛起效快,效果确切,局麻药用量少。Objective To evaluate the optimization strategy of labor analgesia in obese parturients using dural puncture epidural(DPE)combined with programmed intermittent epidural bolus(PIEB).Methods Eighty American Society of Anesthesiologists Physical Status classificationⅠorⅡobese primiparae,who were at full term with a singleton fetus in vertex presentation,aged 20-40 yr,with body mass index of 30-40 kg/m2,at 37-42 week gestation,with cervical dilation of 2-5 cm,and with visual analogue scale score≥50 mm,were divided into 2 groups(n=40 each)using a random number table method:DPE plus PIEB group(DPEP group)and DPE plus continuous epidural infusion group(DPEC group).All parturients received DPE labor analgesia,and parturients received PIEB(DPEP group)and continuous epidural infusion(DPEC group)to maintain analgesia during labor.In DPEP group,the patient-controlled epidural analgesia pump was set up to deliver a 5 ml bolus dose with a 20-min lockout interval and background infusion at 2 ml/12 min after an initial dose of 8 ml.In DPEC group,the patient-controlled epidural analgesia pump was set up to deliver a 5 ml bolus dose with a 20-min lockout interval and background infusion at 10 ml/h after an initial dose of 8 ml.The analgesia solution contained 0.1%ropivacaine plus 0.3μg/ml sufentanil.The time to achieve adequate analgesia,consumption of ropivacaine per unit time,height of sensory block at the thoracic vertebral level,modified Bromage score,effective pressing times of patient-controlled analgesia,the number of rescue analgesia,Apgar score,delivery mode,occurrence of adverse reactions and maternal satisfaction with labor analgesia were recorded.Results Compared with DPEC group,the time to achieve adequate analgesia was significantly shortened,the consumption of ropivacaine per unit time was decreased,and the number of rescue analgesia and effective pressing times of patient-controlled analgesia were decreased in DPEP group(P<0.05).There were no significant differences in the height of sensory block at the thor

关 键 词：镇痛 硬膜外 麻醉 脊椎 镇痛 产科 

分 类 号：R714.3[医药卫生—妇产科学]